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Haiti, Indonesia, Japan … Where Will the Next Crisis Strike?

Emergency physicians are trained to respond to calamitous situations on the fly, but with humanitarian emergencies increasing, doctors must understand their roles and the best way to respond to situations.

“We are the quintessential docs who are able to improvise, adapt, and overcome,” said Robert L. Norris, MD, the chief of emergency medicine at Stanford University Medical Center. “Emergency physicians serve in all roles of disasters, from preventing and mitigating disasters to planning responses to actually responding.” He explained that a system must be in place to respond, particularly when they occur abroad.

The first step is in bridging partnerships on an international level, Dr. Norris said in a lecture at the American College of Emergency Physicians Scientific Assembly. “Don't just pack your bags; get on a plane, and show up,” he said. “You need someone to support you logistically to maximize your effectiveness. This reduces the risk to you and to the situation. If a person just shows up without any plans for food, water, or shelter, they become a drain on the situation. It is important to have a bridging partnership, to be under the umbrella of someone with a footprint in the area who can assist you with logistics.”

Dr. Norris suggested working with clinical operations, academic centers, governmental agencies, NGOs, industries, or sponsors. The January 2010 earthquake that shook Haiti is a prime example. Some 230,000 people were killed, most in the heavily populated capital city of Port-au-Prince. Dr. Norris and a team of physicians and nurses responded to Port-au-Prince following the earthquake, and while he said they helped many people, there was still room for improvement.

Right after the earthquake, Dr. Norris received an email calling for volunteers, and immediately began gathering a team of doctors and nurses for the mission. Stanford hospital had no prepared list of people available for emergency missions, and while he was able to assemble a team, many in the group were not prepared to leave the country. Some needed immunizations; another's passport had expired. A few people had never spent a night outdoors before. The group scrambled to get equipment and medicine.

After accumulating all the gear, establishing contacts, and making the necessary preparations, the group flew to New York for a connecting flight to Santo Domingo, Dominican Republic. Transportation into Port-au-Prince was a challenge. The group was forced to rent buses to get into the city, and along the way they encountered but avoided a pack of looters.

Despite the widespread devastation, many things went right, Dr. Norris said. Briefings and assignments were done well, and the group had ready access to humanitarian aid, and was able to stay in the basement of a hotel.

Improvisational medicine, a must in emergency situations, was successful because of military and wilderness medicine experts in the city, Dr. Norris said, and replenishing supplies and equipment and communicating with patients was successful thanks to translators. Staff members, despite extreme stress, were able to keep track of patients and tag them with potential diagnoses.

The lack of power and security at the hospital initially was troublesome, forcing medical personnel to leave patients at night with reassurances that they would return. The region also suffered from a lack of on-site emergency preparation. When a powerful aftershock struck the area on day eight, patients were evacuated but later refused to go back inside. A quickly installed tent hospital solved the problem.

Dr. Norris said the experience was striking, but noted that many of the problems could have been eliminated with proper preparation. “It made us all realize we needed a different approach,” he said. “We are trying to change all the things that didn't go well.”

Dr. Norris, who has been helping to develop the Stanford Emergency Medicine Program for Emergency Response, said the mission is to develop advanced preparation, response, research, and education for emergency situations. The program is currently developing small, nimble teams to handle situations beyond traditional emergency medicine. Teams will be able to get out the door to a crisis within six hours, and be largely self-sufficient for 72 hours.

Small groups are headed by a team leader, and each team is assigned specific tasks. The program is also using a formulaic approach to calculate the supplies needed for a mission. Manufacturers that can provide equipment have also joined in, while the program continues to research salaries, time off, and insurance policies for team members. The emergency response program is also looking into a security and safety plan, and developing a formal deployment plan so nothing is forgotten.

“We meet on a monthly basis and develop ideas,” Dr. Norris said. We are a lot better prepared than we were two years ago.”

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